#EMconf: Splinting complications

Splinting Complications and Pearls
Heat injury and thermal burnsavoid hot water on plaster
Pressure Sores → secondary to folds and kinks of splint
     ○ Smooth the splint with the palms of your hands to avoid bumps and pressure points
     ○ Support bony prominences with extra webril
          ■ Upper extremity → olecranon, radial styloid, ulna styloid
          ■ Lower extremity → patella, fibula head, malleoli, upper portion of inner thigh
Compartment Syndrome
     ○ Always do a neurovascular exam after reduction/splinting
     ○ Patient may return with splint ‘too tight': may need to remove cast
Contact Dermatitis → secondary to the material and can lead to rash and itching
Fracture blisters → usually from the original trauma but frequently attributed to the splint/ cast because often seen on a second visit
     ○ Inform ortho if seen in ED as operative management may be delayed until wound healing
Joint Stiffness → an expected result of immobilization that can be mild to debilitating
     ○ Leave splints on for only the time period needed to require healing
     ○ Any immobilization that is over 7 days requires orthopedic follow up
Discharge instructions should include:
     ○ Weight bearing status
     ○ Education on using ambulatory adjuncts
     ○ Keeping the splint dry
     ○ Return to ED precautions for neurovascular compromise
     ○ Specific follow-up instructions

Reference: Stacie E. Byers, and Carl R. Chudnofsky. Roberts and Hedges’ Clinical Procedures in Emergency Medicine. 5th ed. Philadelphia, PA. Elsevier INC., Saunders 2014.